What is Foundation Training?
In a nutshell, this is a two-year training program for new medical graduates. It was designed to allow for a more uniform healthcare service across the United Kingdom. It is organized by the UK Foundation Programme Office (UKFPO), which manages the national application process, provides guidance on foundation training, and ensures consistency among programs. When considering the contents of the training, typically, you will rotate between six different specialities within hospitals and the community. During these rotations, you are required to demonstrate your progression through domains correlating professional and clinical competencies (see below).
What is the Application Timeline?
How do I apply?
UK medical graduates will be nominated by their university with applicants providing certain documentation including referees e.g. Personal Tutor. The process is via an application named Oriel.
How do I choose my jobs?
As of June 2023, it was decided that allocations would be based on a system called the "Preference Informed Allocation" (PIA). The 'best-fit' system aims to allocate everyone to one of their top choices, reducing the likelihood of being assigned a lower preference. The PIA system means that the previously used Situational Judgement Test and Educational Performance Measure (EPM) (aka your medical school ranking) no longer count. Read on for a step-by-step overview of the process:
- Medical Schools Nominate Candidates
- Candidates rank Foundation Schools (This is the time to think about which geographic area you want to go to)
- You rank specific programmes (Jobs and rotations) (note sometimes you might have to rank groups of programmes depending on the Trust)
- You will be matched to a programme and after some paperwork, you'll start your job in August!
What about SFP and FPP Jobs?
Specialised Foundation Programme (SFP)?
This was previously called the Academic Foundation Programme. These jobs allow you to get involved in teaching, medical research and leadership opportunities alongside the mandatory competencies of foundation training. A clinical job may be swapped out for a research job, for example.
Foundation Priority Programme (FFP)?
These jobs generally involve recruitment to less popular areas with the trainee possibly being paid a monetary incentive. Just like the standard Foundation Programme, you will have to commit to an area for the entirety of training however, these are commonly in more rural areas and areas with a shortage of clinicians and resources.
Will I get my first choice?
Competition varies between locations each year, take a look at the competition ratios from 2012, 2022 & 2023.
Foundation Application
Frequently Asked Questions - FAQ
Can I defer my job offer?
No, and you cannot appeal your allocation if you aren't happy with it either.
Can I match my application with someone else?
Yes, but you will be allocated by the lower rank of both applications. However, not all Foundation Schools allow matching. Take a look at the right-most column of this table for Foundation School specifics. You should contact specific Foundation Schools for more information. If the PIA system can't rank both applicants in the same area then the applications will become UN-linked and ranked separately.
But, you said that we aren't "ranked" according to our ability so why do you mention ranking?
You're correct, within the PIA system, a rank is still generated for each applicant. This is a computer-generated rank by the Oriel system as the algorithm is run to best match individuals. This has nothing to do with your performance at medical school.
Can I swap my Foundation School or Programme?
Unfortunately not.
What happens if I withdraw my application?
You will have to re-apply for the cycle next year.
What's the process for SFP and FPP applications?
To apply for Specialist Foundation Placements the process will also not use SJT or EPM but will produce its own independent computer-generated ranking system. Alongside this, there are five free-text questions that you will have to answer to evaluate your suitability, motivation and skills.
Can I defer my job offer?
No, you can either choose to accept it or reject it and reapply the following year.
Foundation Years
What does it involve?
This is the period where you will rotate through 6 different speciality jobs over 2 years. This means that every four months you will rotate jobs and learn to work within a new team, with new protocols. To hit the ground running take a look at my Day One Guide.
What are you required to demonstrate?
I bet you're so relieved to be done with all those tick boxes in medical school, right?! I've got some news for you! Sorry, you're not done yet – but don't panic, they're not that bad. To gain full GMC registration (at the end of F1 year) and to show continual professional development throughout your training it is required for you to show that you are a safe and professional clinician. This is done through a set of mandatory sign-offs which will have to be done every year. As you go into speciality training these will change depending on the speciality.
This is done by demonstrating core outcomes relating to:
- Patient care
- Integration into the workforce
- Professionalism
- See more by visiting the UKFPO Website here.
What you need to do:
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Supervised learning Events:
SLEs, such as miniCEX and DOPS, are part of the 2021 curriculum, which does not specify a specific number required. However, you need enough evidence to demonstrate your capabilities. Note: your foundation school may suggest a certain number, for example, a minimum of 5 mini-CEX. -
Reflections:
Engage in reflections on events, cases, or scenarios that you encounter. -
TAB Form:
Also known as 'Team Assessment of Behaviour,' is a requirement to demonstrate your value as a team member. This essentially involves multisource feedback, where you seek input from various members of the MDT. It's not too burdensome, provided you give people enough time and collect emails early. -
Self-directed learning:
Attendance on modules or teaching that has value to you. -
Foundation Teaching:
Attendance of a set number of hours may be required, which may be delivered in-house, such as on Wednesday afternoons. You can log these hours in your Personal Learning Log. -
Supervisor Reports:
At the end of each attachment, you will meet with your clinical supervisor and educational supervisor to discuss the placement, address any concerns, and review your portfolio progress. They will assess your evidence against the required criteria, ultimately determining whether your performance is categorized as unsatisfactory, satisfactory, or exceptional – with 'satisfactory' indicating good performance. - The Placement Supervision Group (PSG) is a form completed by senior staff, such as consultants in your specific rotation. This form aids in informing your clinical supervisor's end-of-placement report.
- The Prescribing Safety Assessment (PSA) is a summative examination in F1 that you must pass.
What shifts will I work?
Shift work can vary depending on the specific job you rotate into. The two foundation years are divided into smaller rotations, totalling six (three per year), with each individual rotation lasting four months. The breakdown typically resembles the following, though it's not exhaustive:
Am I expected to be running a ward on day 1?!
Don't panic! For FY1, it's mandatory to have a shadowing period of roughly 1 week. During this time you will meet the team; complete mandatory induction requirements, and shadow the F1 you will be taking over from.
You are advised not to book any time off in this period, for any reason and it is usually the week before the first Wednesday in August.
When can I go on holiday?
Unfortunately, taking leave is subject to employer policies, and it's generally harder to request time off during twilight shifts, night shifts, and weekends due to the need for adequate cover. Typically, you may need to arrange shift swaps with colleagues to secure these days off. Leave on normal workdays (e.g., 9 am-5 pm) depends on ward cover; if you're the sole staff member on the ward, it might not be permitted. For instance, if you're scheduled Mon-Thurs 9 am-5 pm but have a weekend cover on Sat-Sun (with the following Mon off), you can take leave on Mon-Thurs but need to organize a swap for the weekend shifts. While shift swaps can be challenging, if you ask colleagues early, someone might be willing to exchange shifts. Planning early is advisable.
Alongside this, it's important to note that organising leave four months in advance can be challenging due to the job rotation schedule. Alongside this there will be new rota coordinators every four months so make sure you contact the correct person! During each 4-month block, you're entitled to an average of 9 days of leave. Transferring leave is difficult and only permitted in exceptional circumstances, requiring agreement from seniors, rota coordinators, and potentially educational or clinical supervisors.
Study leave
Study leave is crucial, providing dedicated time away from clinical duties for attending courses and conferences. It's important to check with your local trust on their study leave policies. In some rotations, FY1s may not have complete freedom in choosing what to use it for, as it might be allocated for mandatory courses. During your F2 year and beyond you might have more flexibility with this, check local policy.
Sick Leave
If you're not fit to work for whatever reason, you can take sick leave. This can be up to 7 days of self-certified leave before you need to get a "fit note" (previously called sick note) from your clinician. If you find yourself taking lots of sick leave then you might be required to have a meeting with your Educational Supervisor to check in and consider if extra time is required for you to reach the required competencies to pass the Foundation Year. Each department might have slightly different policies but the basics involve you contacting the consultant and/or rota co-ordinator so your work will be covered.
Bank Holidays
Regarding bank holidays, don't always presume you'll have it free as you may be rota'd in to work them. If you do end up working them then you'll receive time off in lieu to take at a later date.
Time Off In Lieu (TOIL)
Time Off In Lieu (TOIL) is granted only when you have worked more than your scheduled hours. In many trusts, you can only exception report (indicate that you have worked longer than expected) if you exceed a set time over what is expected. For instance, staying late for over 30 minutes or missing dedicated teaching, such as scheduled Foundation Teaching. Exception reporting is crucial for the success of TOIL and can also help raise concerns regarding excessive working hours. This process contributes to potential changes in local shift patterns and highlights the need for extra support so exception report at every opportunity.
Foundation Years
Frequently Asked Questions - FAQ
What happens if I work when the clocks change?
When the clocks change, for Daylight saving time (DST) and British Summer Time (BST), you'll either love it or hate it. In spring, as the clocks go forward it essentially means that you work one less hour that shift! However, in October, with DST the clocks go back one hour meaning that you have to work that extra hour with no extra pay.
Have other questions?
If you have any other questions reach out to us via our Contact Page.
References:
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https://foundationprogramme.nhs.uk/programmes/2-year-foundation-programme/ukfp/
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https://www.bmj.com/careers/article/a-guide-to-the-foundation-programme-for-doctors